title: Role of chest computed tomography in head and neck cancer.
abstract: OBJECTIVE
  To evaluate the role of chest computed tomography (CT) in patients with head and neck squamous cell carcinoma (HNSCC) and to determine the optimal timing and predictive factors for positive findings.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Two hundred seventy screening chest CT scans performed in 192 patients with HNSCC during a 42-month period were reviewed.
  
  
  METHODS
  The scans were categorized as new cases, follow-up cases, or recurrent cases. The results were classified as abnormal or normal. Scans of patients having a radiologic diagnosis of a malignant neoplasm of the lung or an indeterminate lesion were considered abnormal. Factors correlating with an abnormal chest CT scan or development of malignant neoplasm of the lung were analyzed, including the timing of imaging and the patients' clinicopathologic data.
  
  
  RESULTS
  Seventy-nine scans (29.3%) were considered abnormal. The rate of an abnormal scan was significantly higher in the follow-up case group (44.2%) than in the new case group (14.2%) (P < .001). Ten of 15 indeterminate scans (66.7%) with small (<1 cm) solitary pulmonary nodules showed disease progression on subsequent follow-up scans, changing the patients' diagnoses to a malignant neoplasm of the lung. The predictive factors for development of a malignant neoplasm of the lung were initial N2 or N3 disease, stage IV disease, recurrent disease, and distant metastasis to another site.
  
  
  CONCLUSIONS
  Chest CT is recommended for high-risk patients, especially during the follow-up period. Intensified evaluation and management are mandatory for indeterminate small solitary pulmonary nodules because of the high rate of malignant neoplasms.
authors.affiliation: Department of Otolaryngology, Taipei Veterans General Hospital, 201 Shih-Pai Rd, Section 2, Taipei, Taiwan 11217.
authors.forename: Yen-Bin
authors.initials: YB
authors.lastname: Hsu
authors.forename: Pen-Yuan
authors.initials: PY
authors.lastname: Chu
authors.forename: Juhn-Cherng
authors.initials: JC
authors.lastname: Liu
authors.forename: Ming-Chin
authors.initials: MC
authors.lastname: Lan
authors.forename: Shyue-Yih
authors.initials: SY
authors.lastname: Chang
authors.forename: Tung-Lung
authors.initials: TL
authors.lastname: Tsai
authors.forename: Jui-Lin
authors.initials: JL
authors.lastname: Huang
authors.forename: Yi-Feng
authors.initials: YF
authors.lastname: Wang
authors.forename: Shyh-Kuan
authors.initials: SK
authors.lastname: Tai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000556:secondary*; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D013902:Radiography, Thoracic / Q000379:methods; D012042:Registries; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D013624:Taiwan; D014057:Tomography, X-Ray Computed / Q000379:methods*